Quarantined! UHP Staff

When Carl Peterson, a young boy, fell on board the SS Sweden, his parents were concerned but not overly alarmed. But, by the time the ship reached Ellis Island, Carl, who had developed osteomyelitis, a bone infection, was in severe pain. Public Health Service officials who examined Carl sent him to the hospital on the south side of Ellis Island. His terrified parents joined him there.

An operation saved Carl’s leg but during his recovery, Carl contracted diphtheria. A slow recovery followed but in an extraordinary stroke of bad luck, Carl now contracted scarlet fever. Three months after he had arrived in America, Carl Peterson was finally deemed fit to enter the U.S. in January of 1921.

Carl’s story was unusual. Most immigrants landed at Ellis Island, underwent a quick medical inspection by officers of the U.S. Public Health Service, and quickly left the island for New York and other destinations. Of the approximately 10 million immigrants processed at Ellis Island, only 1% to 2% were detained and quarantined at Ellis Island for medical reasons.Quarantine as Disease Prevention

Throughout history, many countries have developed policies to quarantine the sick to prevent the spread of disease. Typically, these policies have been put into place when epidemics raged. In medieval and early modern Europe, for example, many countries used quarantines when epidemics of bubonic plague occurred.

Quarantined man at Ellis Island c1930

Yet despite their widespread use in Europe and America, quarantines have always had a mixed history. In societies which did not clearly understand the exact causes of specific diseases nor the idea of incubation periods (in which a disease might not be evident while it was infectious), quarantines were often ineffective simply because they were imposed at the wrong time.

But quarantines have also been ineffective because societies have had great difficulties enforcing these. When describing the bubonic plague which hit London in 1665 and the city's efforts to impose quarantines, Daniel Defoe noted that people “found so many ways to evade this;” in fact, when families were faced with the possibility of their house being sealed off to quarantine them, “every one escape[d] out of the house who had a mind to escape, whether they were sick or sound.” As a result, quarantining houses “was no way to be depended upon as a sufficient method for putting a stop to the infection.”

But if quarantining people when an epidemic was raging was often ineffective, could quarantines be used to prevent an epidemic beforeit occurred?Quarantine in America

In eighteenth-century America, many leading politicians believed that quarantine could be used to protect the health and prosperity of the new nation. In a world in which most goods were transported by water, sailors played a major role in contributing to the nation’s prosperity. But ships carried not only goods---they also carried diseases into the nation's port cities. Shaped by Enlightenment ideals that championed science, the nation’s founders argued that quarantine could be used to protect these port cities from the spread of diseases.

Insignia of Marine Hospital Service

In 1798, Congress approved the creation of a fund designed for the “temporary relief and maintenance of sick or disabled seamen.” The Act mandated the deduction of twenty cents each month from the salaries of all American seamen; this money was used to fund the Marine Hospital Service, a federal institution that built and supervised a series of hospitals in the nation’s port cities. American seamen who became ill away from home were now entitled to care in any of these hospitals. The hospitals built in the nation’s port cities provided an effective system of quarantine by detaining and then caring for sailors who might carry disease into America’s port cities.

Although this network of hospitals was primarily concerned with protecting the health of sailors, it slowed the spread of epidemics, an especially crucial task in an age when understanding of disease was rudimentary and there were few remedies for most diseases. Simply by isolating sick sailors from healthy citizens, the Act provided port cities with some protection against epidemics.

Paralleling the rise of other similar federal institutions, the hospitals created by the Marine Hospital Fund grew dramatically in number during the first half of the nineteenth century. By mid-century, Marine Hospitals served sailors in ports from New Orleans to Boston. The Act was deemed a major success in its early years but problems developed. The Fund was originally intended to provide health care for the nation’s workforce but it also came to enrich unscrupulous politicians, physicians, and builders. By the advent of the Civil War, the Marine Hospital Service was openly charged with running hospitals for political rather than maritime or health needs. These charges were not entirely without basis. Only eight of the Marine Hospital Service’s twenty-seven hospitals functioned according to their original purpose by the end of the Civil War.

Facing mounting criticism, the Treasury Department, which oversaw the Marine Hospital Service, initiated a study of the fund and its network of hospitals in 1869. The Service’s detractors assumed that the study would recommend the closure of the hospitals but, reflecting a broader trend toward the expansion of government services, it called instead for the Service to continue, although with several fundamental changes. The most important of these recommendations called for the creation of a “Supervising Surgeon of the Marine Hospital.” The “Supervising Surgeon” would oversee the Fund and ensure that the hospitals were properly staffed and efficiently run. John Maynard Woodworth, the first Supervising Surgeon, initiated a radical overhaul of the existing system. Over the course of the next twenty years, Woodworth and his two immediate successors transformed the Service into a dynamic and highly professionalized service which directly cared for all Americans, not simply merchant marines.

Immigrants at Ellis Island wait for a ferry, 1914

Screening in an Age of Mass Migration

Although the newly reformed Marine Hospital Service (later to be renamed the Public Health Service or PHS) continued to care for sick sailors and thereby prevent the spread of disease into the nation’s port cities, the Service gradually expanded its mandate during the late nineteenth century. By the early twentieth century, all travelers, not simply sailors, were screened by Public Health Service at the nation’s port cities before being allowed to disembark. This screening, although it is most strongly associated with Ellis Island, occurred at all of the nation’s ports.

This health screening was not, however, done in a consistent manner. Upper-class passengers who paid higher fares were screened in a more perfunctory and private manner than lower-class passengers, most of whom were immigrants.

But screening also differed depending on one’s place of origin and one’s race. Reflecting beliefs that Asians were more likely to be diseased than Europeans and seeing these immigrants as “less desirable,” the Public Health Service adopted a very different policy when screening Asians at places such as Angel Island (the quarantine station in San Francisco, California). Although white travelers and immigrants entered the United States through Angel Island, PHS officials routinely separated these travelers from their Asian counterparts. Asian travelers and immigrants were also detained (quarantined at Angel Island) for diseases that were not only eminently treatable but which also posed no threat to the American population.

Harsh as these policies were---and they were harsh---the Public Health Service took a radical step by providing health care for most of the immigrants and travelers who were detained for health reasons. Quarantined patients often received state of the art medical care at Public Health Service Hospitals. For most of these patients, being quarantined---at Ellis Island or elsewhere---was simply one stop on the long journey to America. And after receiving a clean bill of health, most, like Carl Petersen, traveled on to meet and rejoin their families in the United States.